advance health care directive
a written document stating an individual's specific wishes regarding his or her health care to be enacted in the event the person is unable to make decisions
coroner's case
a patient death that requires investigation by the coroner, as well as an autopsy on the deceased
cultural competence
the ability to provide support and care to individuals of cultures and belief systems different from one's own
DNAR
Do not attempt resuscitation". Emphasizes the patient's desire to refuse intervention to resuscitate
DNR
Do not resuscitate". An official request to refrain from certain types of resuscitation, usually cardiopulmonary resuscitation
end of life
a period within which death is expected, usually days to months.
heart beating cadaver
a cadaver maintained on cardiopulmonary support to provide tissue perfusion.
Elizabeth Kubler-Ross
a swiss psychiatrist who proposed a theory of developmental or psychological stages of the dying experience
non heart beating cadaver
a cadaver in which perfusion at and after death was not possible
brain death
the diagnosis of ____ ____ is used when the entire brain ceases to function without life support mechanisms in place.
respiration, heartbeat
Some functions such as ___ and ___ can be maintained artificially even during brain death.
real death
In the US, brain death means ___ __, an no other distinction is used for legal or medical purposes.
stages of grief and dying
Kubler Ross model proposed ____
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
What are the stages of grief and dying proposed by Kubler Ross model?
denial stage of Kubler Ross Theory
the patient denies that he or she is dying
anger (stage of Kubler Ross Theory)
Some patients express ____. these feelings may be projected onto family, oneself, health workers, or spiritual entity.
Bargaining
Kubler Ross describes this stage as a way of postponing death. (ex;
I just want to experience one pain free day with my family)
true clinical depression (stage of Kubler Ross theory)
This may occur during the dying process
acceptance stage
In Kubler Ross's theory, death is "accepted.
that it is too constricting and does not allow for individualism in the experience of death
what do critics believe about Kubler Ross theory?
Kubler Ross stages theory
this provided a framework for psychologists and social workers to look at the process of dying in a way that had not been previously studied
keen listening and observation skills
communication with the dying patient requires
that moment and time
It is important to recognize and acknowledge the fact of death and what this means to the patient in ____
any changes in mood or signs of anxiety and fear
as a surg tech, we should be alert to_______ related to death and isolation
anger and frustration
the family's reactions of grief and sadness may be accompanied by bouts of ____ and ___ with the health care system, each other, and even to the dying family member.
socially acceptable
Death triggers large and sometimes unmanageable emotions, and these cannot always be contained in ways considered _
patient's medical condition
the surgical tech should refrain from providing information to family or friends about the
self determination
this is the right of every individual to make decisions about the way he or she lives and dies
advance care planning
this provides an accepted method for individuals to define their needs and wishes about death and dying
ethical issues
this will arise when the patient is not competent to communicate.
family
decisions about end of care fall to the ___ when the patient is not able to communicate his or her wishes
assisted suicide
this is the intentional harm to a person, at their request to promote or cause death
DNR and DNAR
two types of health directives that express the patient's decision to decline lifesaving efforts.
the patient signs a DNR order
the request not to resuscitate is made official when
patient's medical record
A DNR is charted in the
alleviate ambiguity
explicit forms that define precisely the procedures that can and cannot be performed during resuscitation have been designed to
palliative care
this is the medical and supportive care provided to the dying patient
debulking of a tumor or debridement of a pressure wound
numerous types of surgical intervention may be included as a component of palliative care, such as
living will
this specifies the exact nature of palliative care that is accepted by the patient
consensus of the patient (when able)
the family
care providers
in the absence of a living will, clinical decisions sometimes are made by
the right thing
Most people intend to do
personal conflict
Health care workers often face ___ ___ about the decisions made by their patients or the families of patients
obliged to honor them
Health care workers may not agree with the decisions being made about patients, but they are
death
this as perceived across cultures, often is defined through spiritual values and beliefs
validity of a belief or and expression of a patient's faith
Health care workers may question the _______, often comparing it to their own.
valid for the believer
by definition, spiritual beliefs are _____, and do not need approval or justification by others
cultural competence
support and care across cultures is called
comfort as well as heal the living
although grief and other deep emotions are present in all families at the time of death, these feeling often are mitigated by ritual and ceremony, which _____. In many cultures, they also believe to comfort the dead.
special knowledge about the practices of certain cultures
handling of the body, especially its preparation for viewing by the family, may require
surgeon and anesthesia care provider
when death occurs during surgery, who verifies that brain death has occurred (called determination of death)
determining the absence of breathing, response to painful stimuli, and the presence of cranial reflexes
specific medical assessment is carried out on the patient to determine brain death, these include
electroencephalography and computed tomography
more complex tests performed to determine brain death include
the circulator
because death in the OR is a sentinel event, who must initial all forms as for any sentinel event
postmortem care
this prepares the body for viewing by the family and assists in further handling procedures carried out by the morgue and morturary
cool, loose tone
immediately after death, the body begins to __ and all sphincter muscles immediately
dependent areas of the body (those under pressure from body or gravity)
after death, the _____ begin to collect fluid, and the areas around the ears and cheeks may turn purple or red (a condition called liver mortis)
rigor mortis
this is the natural stiffening of the body, begins approximately 15 mins after death and peaks at 8 to 10 hours
regresses
at 18 hours, rigor mortis _____ and the body usually is relaxed after 24 hours
the head (eyelids) and progresses to the feet.
Rigor mortis begins at the
respect
during the aftercare procedure, the body is handled gently and with________ at all times
the circumstances of the death
what determines if a patients death is investigated by the coroner (and requires a mandatory autopsy) .this case is called a coroners case
death in OR or ER
unwitnessed death
death after admission to another facility
death in which criminal activity is suspected
suicide
death of an inmate
death as result of infectious disease
list some circumstances for a coroners case
remain intact for examination and investigation
coroner's cases require that the conditions of the body ___
ensure the vitality of the organ
once the decision has been made for organ recovery, exacting clinical protocols are followed to
ask the family for permission
medical professionals and other caregivers ______ to recover organs from the deceased
regions
donors are registered in ____of the country, and the data exchanged with recovery organizations
American Association of Tissue Banks
the protocols for medical recovery, care of tissue, and identification of tissue are formulated by the
American Association of Tissue Banks
a nonprofit scientific organization that accredits tissue banks and recovery organizations to endure professional standards of practice
the cornea, blood vessels, heart valves, bone and skin
non heart beating cadaver tissues include
the family
when no verifiable permission has been granted by the patient for organ recovery, who may act as a surrogate?
organ removal
many cultures and faiths forbid ____ after death, and these cases usually are straightforward for the family and patient
by law
if no decision has been made by the patient, the attending physician, must _____, ask the patient and family to consider organ donation. In cases of sudden death without clear directives, conflicting views may be held by family members about organ donatio
way of providing life
some families may feel very strongly opposed to organ donation, while others feel that is is a
vary
the emotional and psychological events triggered by the sudden death of a patient may ____ in health care workers.
previous experience with death
support available
the professionals beliefs/values
knowledge about process of death
professional's emotional well being
what factors influence reactions and coping skills for death are available to the professional
true
T/F the types of emotions/psychological events that health care workers experience may be similar to those of the dying patient
shock and denial
these are common in sudden death, especially when the patient is young or the death was violent
the discovery of a special ability to nurture
the ability to provide comfort to both the patient and the family often results in
false
T/F a structured response is not necessary to help health care workers cope with death.
debriefing periods
spontaneous expressions of support
acknowledgment by individual team members
what are some structured responses to help health care workers cope with death
effective and compassionate communication
___ and ___ with the family and the patient is enhanced by understanding some of the more common problems families face
the psychological effects of grief
the patient's medical care
practical aspects of finances and estate issues
understanding the common problems families face with the death of a loved one include